Supporting urgent care using clinical
dashboards: transforming data into
knowledge
Dr Anne Talbot
GP & Urgent Care Clinical Lead, Bolton CCG
Associate Medical Director, Service Transformation,
Greater Manchester
Presentation Overview
 An overview of the Urgent Care Clinical
Dashboard concept (including dashboard
screenshots)
 The local implementation approach
 The project’s current position
 Benefits
 Success factors and key messages
The Urgent Care Clinical Dashboard
Concept
 The dashboard collates the previous day’s urgent care
activity data and brings it all together in a user-friendly
graphical display, integrated with GP practice data
 GP practice staff may access the dashboard on their
desktops via secure login. District nurses and active case
managers can be given access for practices they work
with
 Clinicians can drill down to a more detailed patient-level
view
 Each dashboard is clinically-driven and locally led. Sites
can use existing technology to build their dashboard,
keeping costs down and increasing flexibility
Integrating sources of information
Information From Acute Trust
Walk in Centre
A&E Attendances
Patient
PatientA
PatientF
PatientK
PatientJ
PatientM
PatientJ
PatientK
Attendance Date
01/09/2012
01/09/2012
03/09/2012
02/09/2012
03/09/2012
04/09/2012
08/09/2012
Admissions
Patient
PatientA
PatientK
PatientH
Admission Date
01/09/2012
08/09/2012
04/09/2012
Discharges
Patient
PatientA
PatientK
Discharge Date
08/09/2012
08/09/2012
Information
received separately
from multiple
sources within
different time
frames – making
identifying patterns
difficult
Patient
PatientM
PatientF
PatientJ
PatientM
PatientJ
Attendance Date
01/09/2012
01/09/2012
02/09/2012
03/09/2012
04/09/2012
PatientK
03/09/2012
Out Of Hours
Patient
PatientT
PatientY
PatientJ
PatientK
PatientM
PatientJ
Contact Date
01/09/2012
01/09/2012
02/09/2012
02/09/2012
03/09/2012
04/09/2012
Information From Practice
Practice Disease Register
Patient
PatientT
PatientK
PatientS
Before the Dashboard
Register
Diabetes
COPD
CHD
Integrating sources of information
WiC
Information From Acute Trust
A&E
Patient
PatientA
PatientF
PatientK
PatientJ
PatientM
PatientJ
Attendance Date
01/09/2012
01/09/2012
03/09/2012
02/09/2012
03/09/2012
04/09/2012
PatientK
08/09/2012
Dashboard:
Patient Drilldown - PatientK
Service
Attendance Date
Patient
PatientA
Admission Date
01/09/2012
PatientK
08/09/2012
PatientH
04/09/2012
Attendance Date
01/09/2012
01/09/2012
02/09/2012
03/09/2012
04/09/2012
PatientK
02/09/2012
Register?
COPD
COPD
Admission
Patient
PatientM
PatientF
PatientJ
PatientM
PatientJ
COPD
COPD
OOH
Patient
PatientT
PatientY
PatientJ
PatientK
PatientM
PatientJ
Contact Date
01/09/2012
01/09/2012
02/09/2012
03/09/2012
03/09/2012
04/09/2012
COPD
Information From Practice
COPD
Discharge
Patient
PatientA
PatientK
Discharge Date
08/09/2012
08/09/2012
Practice Disease Register
Patient
PatientT
PatientK
PatientS
Register
Diabetes
COPD
CHD
The original Bolton dashboard
Devon dashboard
Cambridgeshire dashboard
Brighton & Hove dashboard
Brighton & Hove dashboard – risk
Brighton & Hove – drilldown
How Bolton use the dashboard
 Individual patient level
 Practice operational level - identifies issues of
primary care access
 Locality operational level - identifies poor patient
pathways, areas of training need across
professional groups
 Locality strategic level - tool linked to strategic aims,
objectives and plans; A&E frequent attender
initiative, hospital readmission initiative, public
media campaign
Dashboard-enabled change;
practice level
Locality level; A&E attendances
over time
Bolton CCG readmission initiative
Practices were asked to use the Clinical
Dashboard to identify all their discharges,
contact these patients within 48 hours of
discharge and follow up on any problems
identified.
 29.8% reduction in 24 hr readmissions
 15.5% reduction in 48 hr readmissions
 Positive patient feedback
Implementation approach
Project
scoping (4
weeks
approx)
Project
delivery (10
weeks
approx)
Pilot go-live
(4 weeks
approx)
Benefit and Change Management
Clinical Metrics and Safety
Technical
Information Governance
Project Management
Engagement and Communication
Training
Wider rollout
and review
(ongoing)
Implementation approach
 Structure provided to local teams through an implementation
guide and toolkit available on NHS Networks. This provides
templates, guides, standard metrics, data feed specifications
to enable rapid progression.
 Early checks to ensure that key elements for a successful
implementation are addressed. These include:
 clear clinical leadership and engagement with the GP
community;
 assessment of the technical landscape and approach for
sourcing data and delivering the dashboard;
 Information Governance approach;
 and the creation of the clinical group to review and agree
the metrics for inclusion on the dashboard
Typical urgent care metrics
Title
Description
Urgent Contact numbers by
service by time period
Provides number of patient contacts at each of the various local,
unscheduled care services yesterday, last 7 days and last 30 days
Urgent Contact numbers time
series
(by service or aggregated)
Provides number of patient contacts at each of the various local,
unscheduled care services as a timeline over the last 30 days
Urgent Contact numbers time
series with comparison to
previous year
Provides a comparison of this year’s activity with the same period
last year
Urgent Contact numbers by
time-bands
Provides details of the spread of urgent care contacts during a 24hr
period
Urgent Contact numbers
comparison between GP
Practice and Peer Group
Provides a comparison for each GP Practice of the urgent care
activity for their patients compared to an agreed peer group’s
activity (e.g. CCG or like Practices by Demographic)
Urgent contact numbers
grouped by number of contacts
Provides a view of the numbers of patients with a given number of
contacts in the given time period e.g. 10 patients with 3 contacts in
last 7 days
Patient list by highest urgent
contacts
Provides list of patients typically by NHS Number who have the
most frequent contacts in the last 7 days.
This is supported by a number of drill down views to enable clinicians to see
patients’ details, the nature of urgent care contacts and supporting information
like risk scores (from a risk stratification module) and disease register information.
Dashboard implementation sites
NHS Bolton
South Cheshire and Vale Royal
GP Commissioning Consortia
NHS Merseyside (NHS Liverpool,
NHS Halton & St Helens, NHS
Knowsley, NHS Sefton)
NHS Tees (NHS Hartlepool, NHS
Middlesbrough, NHS Stockton-onTees, NHS Redcar & Cleveland)
NHS Gateshead
NHS County Durham and Darlington
NHS Manchester
NHS Calderdale
NHS Central Lancashire
Lancaster Morecambe Carnforth
& Garstang CCG
NHS Northamptonshire
NHS Leicester City, NHS
Leicestershire County
and Rutland
NHS Oldham
NHS Tameside & Glossop
NHS Trafford
NHS Cambridgeshire
NHS Peterborough
NHS Stoke on Trent and
NHS North Staffordshire
NHS Luton
NHS North Essex
NHS Devon
NHS Suffolk
NHS Torbay
NHS Plymouth
NE Lincolnshire
Care Trust Plus and
partners
NHS Oxfordshire
NHS Brighton and Hove
NHS Southampton
NHS East Sussex Downs
and Weald
KEY
NHS Buckinghamshire
Sites with live dashboards
Sites in implementation phase
Further scheduled dashboard deployments
Medlinc CCG/NHS Surrey
Central London
Healthcare Partnership
Current position: dashboard project
 32 sites now have a live Urgent Care Clinical Dashboard. The
dashboard is available to over 1000 GP practices, and covers
a patient population of around 6.3 million. This will increase to
2000+ practices and 13.5 million patients when sites
currently implementing complete their rollout to GP practices
 Early implementers are adding further content to their
dashboards, e.g. risk scoring, additional data feeds (e.g.
ambulance), a pseudonymised organisation-wide view, yearly
activity comparisons
 Refined implementation toolkit, templates, tools and guide
available to all at our NHS Networks site:
www.networks.nhs.uk/nhs-networks/qipp-urgent-care-gpdashboard
 Dashboard User Group established, run by sites for sites
Emergent benefits at live dashboard sites
Reduced A&E attendances
Reduced/prevented Emergency/Non-Elective admissions
Shorter stay for some patients in unscheduled care via earlier, supported discharge
Reduced prescribing waste
More timely information on attendances, admissions, & discharges, enabling more
proactive care
Enables quicker and improved support for hospitalised patients
Increased awareness of data quality issues from unscheduled care settings
Improved communication between clinicians from different teams/organisations
Increased awareness of unscheduled care activity of patients resident in care homes
and for patients with long-term conditions
Increased visibility of:
• touch points within patient pathways
•inappropriate unscheduled care attendances during practice hours
• patients who will benefit from active case management
• primary care access issues
• (for GP practices) how they perform compared to peer practices/consortium
average
• spend against budget at practice/locality level
• unscheduled care activity for commissioning support staff
Increased identification of opportunities for patient education re: use of unscheduled
care
Critical success factors
Clinical Leadership:
•Demand led (not pushed)
Local Informatics
Capability:
Demand led
clinical
leadership
•Information available
from source systems
•Reasonable
understanding of
Business Intelligence
solutions
•Moderate capability to
transform and
manipulate information
to generate metrics
•Encourage sharing and reuse
•Successful projects will lead to more
success
•Repeatability and lower risk
•Executive level sponsorship
Improvement
mindset and
capabilities
Informatics
Capability
Access to best practice:
•Local clinical ownership during
project and beyond
Improvement Capabilities:
Access to
•Dashboards are a tool not the solution
‘Best Practice’
•Clinical change management and
improvement support to drive benefits
•Linking dashboard to local
improvement initiatives
Lessons Learned/Key Messages
 It’s never too early to engage
with clinicians, data providers, or
IG leads
 Keep focusing on the benefits
which the dashboard will deliver
 Often, simplest is best
 Use the resources and support
available; someone has probably
solved your problem already!
 The dashboard is an enabler; it’s
what you do with the information
it provides that makes the
difference
Any questions?
clinical.dashboard@nhs.net
www.networks.nhs.uk/nhs-networks/qippurgent-care-gp-dashboard
QIPP Digital Technology:
Working with national and local teams to
exploit digital technology in order to
accelerate delivery of their QIPP priorities
http://www.networks.nhs.uk/nhsnetworks/qipp-digital-technology-and-vision
qippdt@nhs.net